Geiger Terrence L, Woodard Paul, Tong Xin, Srivastava Deo Kumar, Johnson Robyn, Turner Victoria, Hale Gregory, Richardson Stacye
Department of Pathology, Mail Stop 341, St. Jude Children's Research Hospital, 132 North Lauderdale Street, Memphis, TN 38105-2794, USA.
Br J Haematol. 2002 Jun;117(3):634-41. doi: 10.1046/j.1365-2141.2002.03465.x.
Platelet refractoriness due to human leucocyte antigen (HLA) alloimmunization is a significant risk to allogeneic bone marrow transplant recipients. To identify factors contributing to this risk, we reviewed the records of 317 consecutive, paediatric, allogeneic bone marrow transplant recipients at a single institution. The 6-year estimated cumulative incidence of platelet refractoriness due to HLA alloimmunization was 2.6% +/- 0.9%. The incidence among patients with chronic myelogenous leukaemia (CML) 12.5% +/- 5.3% was significantly greater than that of other patients (1.1% +/- 0.6%, P < 0.001). Graft rejection (P = 0.003) and the number of platelet transfusions during the first 90 d after bone marrow transplantation (BMT) (P = 0.0025) were also significantly associated with alloimmunization. The association with CML and with graft rejection was not seen among patients alloimmunized before transplantation. Eight patients developed alloimmunization, of whom three had mismatched grafts and four had unrelated grafts. Alloantibody specificities, identified in seven patients, were unrelated to host or graft major histocompatibility complex (MHC). Host recognition of alloantigens in transfused blood products, not graft-host recognition, therefore seems predominantly responsible for the alloimmunization. These results show that paediatric CML patients have a significantly increased risk of platelet refractoriness due to HLA alloimmunization after BMT. Identifying the mechanism for the increased alloimmunization risk may assist in the development of therapies to prevent platelet refractoriness.
由于人类白细胞抗原（HLA）同种免疫导致的血小板输注无效对异基因骨髓移植受者来说是一个重大风险。为了确定导致这种风险的因素，我们回顾了一家机构连续317例儿科异基因骨髓移植受者的记录。因HLA同种免疫导致的血小板输注无效的6年估计累积发生率为2.6%±0.9%。慢性粒细胞白血病（CML）患者中的发生率为12.5%±5.3%，显著高于其他患者（1.1%±0.6%，P<0.001）。移植物排斥（P=0.003）以及骨髓移植（BMT）后前90天内的血小板输注次数（P=0.0025）也与同种免疫显著相关。在移植前已发生同种免疫的患者中未发现与CML和移植物排斥的关联。8例患者发生了同种免疫，其中3例移植不匹配，4例移植无关。在7例患者中确定的同种抗体特异性与宿主或移植物的主要组织相容性复合体（MHC）无关。因此，似乎主要是宿主对输注血液制品中同种抗原的识别，而非移植物-宿主识别导致了同种免疫。这些结果表明，儿科CML患者在BMT后因HLA同种免疫导致血小板输注无效的风险显著增加。确定同种免疫风险增加的机制可能有助于开发预防血小板输注无效的治疗方法。
